ARTERIOVENOUS MALFORMATION, LEFT FRONTOPARIETAL AREA, WITH MASS EFFECTS

An arteriovenous malformation is a tangled cluster of vessels, typically located in the supratentorial part
of the brain, in which arteries connect directly to veins without any intervening capillary bed. The lesion
may be compact, containing a core of tightly packed venous loops, or it may be diffuse, with anomalous
vessels dispersed among normal brain parenchyma.

Categorization of AV Malformations:
PIAL AV MALFORMATIONS
Supplied by the internal carotid or vertebral
circulation
Almost exclusively congenital
Asymptomatic until 3rd – 4th decade of life
DURAL AV MALFORMATION
Supplied by the external carotid artery
Secondary to trauma, surgery or thrombosis
Pulsatile tinnitus, headaches

CT scanning of AVMs of the brain can show an isoattenuating-to-hyperattenuating hemispheric mass, as

well as detect an accompanying abnormal vascular supply. In the absence of hemorrhage, nonenhanced
CT scanning can demonstrate small foci of calcification in as many as 30% of patients. Other possible
findings include cystic cavities representing previous hemorrhage and hypoattenuation of surrounding
parenchyma representing encephalomalacia, cerebral atrophy, or gliosis.

Contrast-enhanced CT scanning can demonstrate serpiginous vascular enhancement that is uniquely

typical of an AVM. Occasionally, CT scans can demonstrate edemas, mass effect, or ischemic changes that
may be associated with AVMs, and further contrast-enhanced imaging may identify small AVMs missed
by plain CT examination.

The degree of confidence is moderate with CT. Typically, an additional study, such as MRI or catheter
angiography, is necessary to confirm the presence of an AVM; however, this is not always needed.